Bill To Information:
First Name:
Last Name:
Title:
Home Or Business
Address:
City:
State:
Zip:
County:
Email Address:
Fax:
Home Phone:
Business Phone:
Employer:
I am a(n):
SB 40 Board Member
Professional Staff
Support Staff
Parent / Family Member
Person w/ Disability
Other
IF YOU NEED ACCOMMODATIONS (ADA Accessibility), PLEASE DESCRIBE:
CHECK APPROPRIATE BOX IF YOU NEED:
Vegetarian Meal
Special Diet (Please Describe)
Sessions:
Please ENTER THE NUMBER of the session you will attend for TIME FRAME. This information is needed to make room assignments and to avoid overcrowding the sessions. SESSIONS MAY BE LIMITED BECAUSE OF SPACE SO REGISTER EARLY. Thank you for your cooperation
Thursday, October 14, 2010
Friday, October 15, 2010
Session #
Session
Time
Session #
Session
Time
Pre-Conference (1 - 3)
9:00 - 10:45 a.m.
Sessions (12 - 13)
3:15 - 4:00 p.m.
Key Note (4)
12:00 - 1:00 p.m.
Sessions (15 - 19)
4:30 - 5:30 p.m.
Sessions (5 - 6)
1:30 - 2:30 p.m.
Sessions (20 - 24)
8:30 - 9:30 a.m.
Sessions (7 - 9)
1:30 - 2:45 p.m.
Sessions (25 - 29)
9:45 - 10:45 a.m.
Sessions (10, 11, 14)
3:00 - 4:00 p.m.
Brunch (30)
11:00 a.m. - Noon
REGISTRATION FEES: Please check the box for the one you need.
Early Bird (before 9/17)
After 9/17
Conference Only
$115
$155
Pre-Conference and Conference
$155
$195
Pre-Conference Only
$50
$90
Brunch Only (non-conference participants)
$24
Please Enter Your Name How You Want Your Name Tag To Appear:
First Name:
Last Name:
Total Amount:
Payment Options:
Pay by Check/Invoice (invoice will be sent to contact listed)
Paying
multiple
registrations with one credit card (MasterCard/ Visa/ Discover)
Paying
one
registrations with one credit card (MasterCard/ Visa/ Discover)
For Office Use Only
QUESTIONS? Call the MACDDS Office at (573) 632-2700
Fax: (573) 632-6678